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Outcomes For Renal Transplant Recipients After Thoracic Endovascular Aortic Repair
Min Li Xu, Gabriel Rodriguez, Heepeel Chang.
Westchester Medical Center, Valhalla, NY, USA.
Abstract
Objective:Renal transplantation increases on an annual basis with better survival rates and improved quality of life for patients with end-stage kidney disease. However, there is very little literature on how renal transplant recipients (RTR) fare after thoracic endovascular aortic repair (TEVAR). This study investigates the perioperative outcomes and long-term survival of RTR compared to patients without end stage kidney disease after TEVAR.
Methods:The Vascular Quality Initiative (VQI) database was used to identify all patients undergoing elective TEVAR from 2003 to 2021. Descriptive analysis was performed between RTRs and non-renal transplant patients with no end-stage kidney disease diagnosis. The findings included mortality, acute kidney injury (AKI), major adverse cardiovascular events (MACE), and aortic re-interventions.
Results:There were 14,261 non-renal transplant patients and 42 functioning RTRs, who underwent elective TEVAR. Aortic dissection was the most common pathology treated with TEVAR. RTRs were less likely to be a current smoker or have history of smoking, but more likely to be on anticoagulation medication. Among the RTRs, average operative time was 190 minutes with 218cc of blood loss, and 1 (2.4%) patient required open conversion. Post-operatively, there were 3 mortalities in RTRs group. In terms of morbidity among the RTRs, 13 (31%) developed AKI, however there were no lower extremity ischemia complications and no one required aortic re-intervention.
Conclusions:The number of functioning RTRs who underwent successful elective TEVAR remains small. The most common post-operative complication among the RTRs is AKI. Therefore, just like RTRs who undergo elective infrarenal endovascular aortic repairs, there needs to be protocols to help optimize these patients pre-operatively and support them post-operatively as they recover from AKI.
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